Children & Sleep Problems

Many kids have sleep problems. Examples include:

• Bedwetting
• Difficulty falling asleep
• Feeling sleepy during the day
• Frequent awakening during the night
• Having nightmares; or
• Talking during sleep
• Teeth grinding and clenching
• Waking early
• Waking up crying

Many childhood sleep problems are related to poor sleep habits or to anxiety about going to bed and falling asleep. Persistent sleep problems may also be symptoms of emotional difficulties. "Separation anxiety" is a developmental landmark for young kids. For all young kids, bedtime is a time of separation. Some kids will do all they can to prevent separation at bedtime. However, to help minimize common sleep problems, a parent should develop consistent bedtime and regular bedtime and sleep routines for kids. Moms and dads often find that feeding and rocking help an infant to get to sleep. However, as the youngster leaves infancy, moms and dads should encourage the youngster to sleep without feeding and rocking. Otherwise, the youngster will have a hard time going to sleep alone.

Nightmares are relatively common during childhood. The youngster often remembers nightmares, which usually involve major threats to the youngster's well-being. Nightmares, which begin at a variety of ages, affect girls more often than boys. For some kids nightmares are serious, frequent, and interfere with restful sleep.

Sleep terrors (night terrors), sleepwalking, and sleep talking constitute a relatively rare group of sleep disorders, called "parasomnias." Sleep terrors are different from nightmares. The youngster with sleep terrors will scream uncontrollably and appear to be awake, but is confused and can't communicate. Sleep terrors usually begin between ages 4 and 12. Kids who sleepwalk may appear to be awake as they move around, but are actually asleep and in danger of hurting themselves. Sleepwalking usually begins between ages 6 and 12. Both sleep terrors and sleepwalking run in families and affect boys more often than girls. Most often, kids with these sleep disorders have single or occasional episodes of the disorder. However, when episodes occur several times a night, or nightly for weeks at a time, or interfere with the youngster's daytime behavior, treatment by a youngster and adolescent psychiatrist may be necessary. A range of treatments is available for sleep disorders.

Sleep wake reversal may occur in some teens and may cause problems with daily life. Sleep can also be disturbed by mood disorders, PTSD, substance abuse, ADHD, and anxiety.

Fortunately, as they mature, kids usually get over common sleep problems as well as the more serious sleep disorders (parasomnias). However, moms and dads with ongoing concerns should contact their pediatrician or directly seek consultation with a youngster and adolescent psychiatrist.

Pointers for Parents —

1. Educate yourself about adolescent development, including physical and behavioral changes you can expect, including those that relate to their sleep needs and patterns. 2. Look for signs of sleep deprivation (insufficient sleep) and sleepiness in your child -- keep in mind that they are not always obvious. Signs include difficulty waking in the morning, irritability late in the day, falling asleep spontaneously during quiet times of the day, and sleeping for extra long periods on the weekends. In addition, sleepiness can also look similar to attention deficit hyperactivity disorder. Above all, don't allow any family member to drive when sleep deprived or drowsy. 3. Enforce regular sleep schedules for all kids and maintain appropriate schedules as they grow older. To help induce sleepiness in adolescents, establish a quiet time in the evening when the lights are dimmed and loud music is not permitted. 4. Talk with your kids about their individual sleep/wake schedules and level of sleepiness. Assess the time spent in extracurricular and employment activities with regard to their sleep patterns and needs, and make adjustments if necessary. 5. Encourage your kids to complete a sleep diary for 7 to 14 consecutive (and typical) days. The diary can provide immediate information on poor sleep hygiene, and it can be used to measure the effectiveness of efforts to change. Be sure to share the sleep logs or diaries with any sleep experts or other health professional who later assesses your child's sleep or sleepiness. (Why not keep your own sleep diary as well?) 6. If your child's sleep schedule during vacation is not in sync with the upcoming school schedule, help him or her adjust it for a smooth transition. This process can take from several days to several weeks, so plan ahead! 7. If conservative measures to shift your child's circadian rhythm are ineffective, or if your child practices good sleep hygiene and still has difficulty staying awake at times throughout the day: (a) Consult a sleep expert. Excessive daytime sleepiness can be a sign of narcolepsy, apnea, periodic limb movement disorder and other serious but treatable sleep disorders; (b) Discuss with teachers and school officials ways to accommodate your child's needs, if necessary. Excessive daytime sleepiness due to sleep disorders or other medical conditions are covered under the Americans with Disabilities Act and the Disabilities Education Act of 1997. 8. Be a good role model: Make sleep a high priority for yourself and your family and practice good sleep hygiene. Listen to your body. If you are often sleepy, get more sleep at night, take naps, or sleep longer when possible. Consult a sleep expert if needed. 9. Actively seek positive changes in your community by increasing public awareness about sleep and the harmful effects of sleep deprivation, and by supporting sleep-smart policies. Request sleep education in school curricula at all levels and encourage your school district to provide optimal environments for learning, including adopting healthy and appropriate school start times for all students.

Here are some "Do’s and Don’ts":

DO:

• Keep to a regular daily routine—the same waking time, meal times, nap time and play times will help your baby to feel secure and comfortable, and help with a smooth bedtime. Babies and kids like to know what to expect.
• Make bedtime a special time. It should be a time for you to interact with your kid in a way that is secure and loving, yet firm. At bedtime, spend some special time with your kid. Be firm and go through a certain bedtime routine that your kid is used to. At the end of that routine the lights go off and it is time to fall asleep.
• Make sure the sleep routines you use can be used anywhere, so you can help your baby get to sleep wherever you may be.
• Make sure your kids have interesting and varied activities during the day, including physical activity and fresh air.
• Put some thought into finding your kid’s ideal bedtime. In the evening, look for the time when your kid really is starting to slow down and getting physically tired. That's the time that they should be going to sleep, so get their bedtime routine done and get them into bed before that time. If you wait beyond that time, then your kid tends to get a second wind. At that point they will become more difficult to handle, and will have a harder time falling asleep.
• Some babies are soothed by the sound of a vaporizer or fan running. This "white noise" not only blocks out the distraction of other sounds, it also simulates the sounds babies hear in the womb. Small, portable white noise machines with a variety of different sounds are now available.
• Use a simple, regular bedtime routine. It should not last too long and should take place primarily in the room where the kid will sleep. It may include a few simple, quiet activities, such as a light snack, bath, cuddling, saying goodnight, and a story or lullaby. The kinds of activities in the routine will depend on the kid’s age.
• Use light to your advantage. Keep lights dim in the evening as bedtime approaches. In the morning, get your kid into bright light, and, if possible, take them outside. Light helps signal the brain into the right sleep-wake cycle.

DON’T:

• Don’t fill up your kid’s bed with toys. It’s probably best to keep your kid’s bed a place to sleep, rather than a place to play. Too many toys in the bed can be distracting. One or two transitional objects--like a favorite doll, a security blanket, or a special book--are okay, and can help with separation issues. Babies under 4-6 months should have an empty crib to prevent suffocation.
• Don’t give your kid foods and drinks with caffeine in them, like hot chocolate, tea, cola, chocolate, etc. Even caffeine earlier in the day could disrupt your kid’s sleep cycle.
• Don’t start giving solids before about 6 months of age. Starting solid food sooner will not help your baby sleep though the night. In fact, if you give your baby solids before their system can digest them, they may sleep worse because they have a tummy ache! The American Academy of Pediatrics says that breast milk or formula is all a baby needs to eat until six months of age. Contrary to popular belief, a heavier baby or a baby with a stuffed-full tummy is not more likely to sleep through the night.
• Don't let your kid watch more than one to two hours of TV during the day, and don't let them watch TV at bedtime at all. TV viewing at bedtime has been linked to poor sleep.
• If your kid has a TV set in their bedroom, remove it. Research shows watching TV is linked to sleep problems, especially if the TV set is in the kid’s bedroom. The presence of other media, such as a computer, video games or Internet in a kid’s bedroom is also associated with worse sleep.
• Never soothe your kid to sleep by putting them to bed with a bottle of juice, milk or formula. Water is okay. Anything other than water in the bottle can cause baby bottle tooth decay. Feed or nurse your baby, and then put them down to sleep.
• Never use sending your kid to bed as a threat. Bedtime needs to be a secure, loving time, not a punishment. Your goal is to teach your kids that bedtime is enjoyable, just as it is for us adults. If the feeling around bedtime is a good feeling, your kid will fall asleep easier.

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